Lung cancer has long been one of the scarier cancer diagnoses because it’s often caught at later stages, and it has — until recently — been very difficult to treat. But that story is starting to change, say experts. More patients are responding to new therapies and surviving longer.

“There’s evidence that we can even change outcomes for patients with advanced disease,” says Bruce Johnson, MD, the board president of the American Society of Clinical Oncology and a co-leader of the Dana-Farber/Harvard Cancer Center Lung Cancer Program.

One thing to note: You won’t see these gains reflected in survival statistics just yet. Survival statistics typically lag by several years. But take heart! The positive numbers are here — and more are in the pipeline.

What’s driving the sunnier outlook for lung cancer?

1. Targeted Therapies

In the past, the main drug treatments for lung cancer were all standard chemotherapy drugs. None of them had a very high success rate in lengthening the lives of lung cancer patients. But in the past 13 years, a number of targeted therapies — medications that address the genetic or molecular flaws that allow lung cancer cells to grow — have been identified.

“There are now four different genomic changes for which there are targeted therapies for non-small-cell lung cancer,” Dr. Johnson says. “And there may be treatments for more mutations coming. An estimated 20 to 25 percent of people have a genomic change for which we have a targeted therapy.”

2. Immunotherapy

In recent years, a fourth mode of treatment — on top of longtime standard treatments like radiation, surgery, and chemotherapy — has emerged from research labs. Called immunotherapy, it unmasks cancer cells that are hiding from the immune system, allowing the immune system to “see” them and attack. Immunotherapy constitutes the hottest advance in cancer in years, and lung cancer patients have been among the first to benefit.

In 2015, the Food and Drug Administration (FDA) approved the first immunotherapy, Opdivo (nivolumab), for patients with advanced non-small-cell lung cancer. More recently, an immunotherapy drug called Keytruda (pembrolizumab) was approved as a first-line therapy (meaning patients can opt for it before surgery, radiation, or chemotherapy) for newly diagnosed patients. Patients are first tested to see if their cells carry a biomarker called PD-L1, which the drug needs in order to work.

“It has transformed the care of our patients,” says Johnson of the PD-L1 test and immunotherapy. “This is one of the few advances where we are beginning to see a dramatic difference in survival.” So far, 10 to 20 percent of lung cancer patients treated with immunotherapy go three to five years without their cancer recurring — and new immunotherapies and immunotherapy combinations are coming. Another heads up: Make sure your doctor tests your tumor for PD-L1.

3. Scientists Expect to Discover More Mutations and Genomic Changes

“We think it’s likely that we’ll identify more mutations that are treatable,” says Johnson. Many of these mutations can be treated with existing therapies, or scientists can try to develop therapies that address specific mutations. Just this past June, for example, the FDA approved a combination of therapies — Tafinlar (dabrafenib) and Mekinist (trametinib) — for patients with non-small-cell lung cancer with a mutation called BRAF.

Moreover, at a recent meeting of the American Society of Clinical Oncology, researchers presented data on a targeted therapy that works on a family of mutations known as tropomyosin receptor kinases, or TRK, found in more than a dozen types of cancer, including non-small-cell lung cancer.

“The good news is that with immunotherapy and targeted therapies, about 40 to 50 percent of lung cancer patients can be treated with something other than chemotherapy,” says Johnson.

4. Access to Screening Means Earlier Diagnosis

Lung cancer is often diagnosed when the cancer is advanced and difficult to treat. But some people considered high risk for lung cancer — like longtime smokers — can now opt for low-dose computed tomography (CT) screening. “The vast majority of these people have it picked up pretty early” when the cancer is much more treatable and survival rates are higher, says Johnson.

A major study called the National Lung Screening Trial examined more than 50,000 people ages 55 to 74 who were longtime heavy smokers and found that people who underwent low-dose CT had a 15 to 20 percent reduced risk of dying from lung cancer than those who received chest X-rays.

Low-dose CT screening has been approved for use and reimbursement by the Centers for Medicare and Medicaid Services (CMS). Other insurers often cover the test, too.

5. Fewer People Smoke

Not all — but the majority — of lung cancer can be traced to smoking. We’ve come a long way since the 1950s, when doctors used to be featured in ads touting the health benefits of lighting up. Thanks to public health measures like continued public education, smoking-cessation classes and programs, medications, and taxes on cigarettes, smoking rates in the United States have been falling since 1990. Today, there are about one-third fewer lung cancer deaths compared with three decades ago.

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